kids

What To Do if Your Child Can’t Poop

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Today’s blog was written by Dr. Prakar Poudel, MB.BS, Medical Graduate, Future Pediatrician!

Is your child not passing stool ?

Many parents just like you visit the doctor when their child doesn’t pass stool for many days. But how many days are too many? How hard is too hard? How large too large? Should it hurt? Bleed?

You should suspect constipation if your child does not pass stool for about 5 days (unless they are a breast fed infant – they can average 2 weeks!). Constipated stool should be large and hard, sometimes painful, and sometimes have a little bright red blood from splitting the skin at the anus.

Around 30% of children below 5 years of age will experience constipation at some point, especially during their pre-school years. The causes of constipation in children can be confusing, but you can rule out a few common causes before a doctor’s visit.

Common Causes:

If your child drinks little fluid or a lot of milk, eats a lot of cheese or loads of highly processed foods, or eats few fiber rich foods, they can have difficulty passing stool daily.

Sometimes, they may also be hesitant to pass stool in a public toilet. Because of this nervousness, they also may not want to go at day-care or school. He or she may need patience and encouragement to ease their hesitancy in public toilets.

What is constipation?

So, how do you know if your child is constipated? The list below can help parents like you identify the problem. If:

  • they pass stool less than 2 times in a week
  • the stool is hard and thick.
  • they cry while passing stool
  • they take a long time in toilet
  • the passed stool has bright red blood on it
  • their belly hurts and is relieved by passing stool
  • their belly is distended
  • they pass foul-smelling gas

What to do?

All these signs are concerning, but can usually be resolved at home by giving your child an adequate amount of fluids and fiber-rich foods. Highly processed food should be minimized at this time, and limit dairy products. This is the only time your pediatrician will recommend sugary drinks, because sugar will draw water into the bowel. (White grape juice will match most carpets.)

As a parent, you should also be aware that children (and puppies!) will generally pass stool soon after they eat due to the gastrocolic reflex. This is very helpful in toilet training or with mild constipation. It is suggested that you keep your child for 5-10 minutes on the toilet after meals, even without any urge to pass stool. Keep special toys or books nearby that can only be played with while on the potty. We want this to be fun!

When to worry

Besides these common causes, medical causes like hypothyroidism, cystic fibrosis, celiac disease will always need a pediatrician visit. So, when should you visit a pediatrician with your child? Below are of some signs to guide that decision:

  • If your baby does not pass stool within 48 hours after birth.
  • If the baby is less than 1 month old
  • If the stool is ribbon-shaped
  • If a child is not gaining weight and height as per the growth chart
  • If your child is also vomiting
  • If a hair tuft or dimple is seen on the back of your child
  • If your family history has Hirschprung disease or cystic fibrosis
  • If the belly of your child is grossly distended
  • if he or she is leaking liquid stool
  • if they pass stools so large they clog the toilet

As always, if you have any questions, call your pediatrician. They love this stuff.

Pediatricians are weird.

What Does that Growth Chart Mean?

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Today’s post is brought to you by Prakar Poudel, International Medical Graduate, Future Pediatrician!

Growth is what makes children unique.

Everyone from Grandma to your neighbor watches the growth and development process from the moment your child is born until they become a fully mature adult. Natural laws dictate that the growth of each child is a unique, continuous and orderly process, although the different parts of a child can grow at different rates!

It is essential for your pediatrician to monitor the growth of your child until they are through adolescence, because changes in growth could be a sign of medical illness.

The most common measures to track are weight and height. However, the eruption of teeth and measurement of head circumference, chest circumference, mid-upper arm circumference and body mass index are other measures for tracking growth.

In general, a child:

  • doubles birth weight by age 6 months
  • triples birth weight by 12 months
  • quadruples birth weight by 2 years

Similarly, a child’s height:

  • will be around 50 cm (~20 in) at birth
  • will gain an additional 25cm (~10 in) by 1 year
  • 12.5 cm (~5 in) by 2 years, and
  • 10 cm (~4 in) by 3 years of age

One important note is that if growth in height is less than 4 cm (~1.6 in) per year after the age of 4 years, this suggests the child has a poor growth rate and needs a pediatrician’s visit.

The head circumference of a baby also increases at the rate of 2 cm (~.8 in) per month until 3 months of age and 2 cm per 3 months until 12 months of age.

If the measurement of the mid part of the biceps (upper arm) is below 12.5 cm in a newborn, the child also needs immediate medical attention. Average biceps size is in the graph below:

Lastly, teeth can also be considered a vital measure to track the child’s growth. As the child grows, primary (temporary) teeth erupt and fall in synchrony with the eruption of permanent teeth. All the temporary teeth fall and get replaced by permanent teeth by the age of 12 years.

Each child’s growth rate and velocity will be different and unique, so the Center for Disease Control (CDC) has created growth charts for weight, height and head circumference for each sex and age to monitor the overall growth of your child. The charts shown below are an example of growth charts of weight for age in boys and girls. All other kinds of growth charts can be found in your nearby children’s doctor.

A single appropriate growth chart is used for each child. The important part of plotting in these charts is that your child should be following a consistent percentile for it to be considered adequate growth. If your child’s weight crosses at least 2 percentiles – say falls from 75th percentile to the 25th – your child may need to see a pediatrician.

Any worries? Pediatricians love this stuff – call yours!

How to Get Kids to Do Their Homework

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girl with books-01If it seems like you are always fussing at your child to get his or her homework done, it’s because you are always fussing at your child to get his or her homework done. There are more than 2000 school days in your child’s life, all of which seem to end with homework. Over time that means you need to inspire your children to do about 4000 hours of schoolwork at home, when friends and screens are calling their names.

I, of course, have a few suggestions on how to get that mountain of homework done with less argument and frustration:

First, establish the habit of homework long before they actually have any. When they are little, arrange time in the evening when the TV is turned off, activities are done, and you as a family can sit and read, build things, or play games that involve a little brain work. Do this during the two hours before bed and the kids will also sleep better.

Keep the goal in mind. What do kids gain from doing homework? We want them to learn the material, of course. More importantly, we want them to learn how to learn, and to love doing it. We want to furnish them with skills that will prove useful in real life. If homework can teach your children to examine facts, explore knowledge, organize and take personal responsibility for their work, and manage their time efficiently – what might he or she accomplish in life? These are the very skills that form a foundation for success.

Where to do it? Choose a place. There is no “right” place. If your child learns better in a quiet environment, a desk in his or her room would work well. If she needs a little supervision, the kitchen table might work better. Wherever you choose, turn off the TV, videogame, and cell phone (quiet music is usually fine, and sometimes can even help children concentrate). Make sure they are comfortable and the lighting is good. Have the supplies they need – pencils, paper, calendar, dictionary? – nearby. Get rid of any distractions.

When to do it? Pick a time. Again, there is no “right” time. Some kids will do better right after school; some will need to blow off steam and may do better after dinner. Choose the time that works best for your individual children, involving them in the decision. Then make this schedule a routine, because children’s brains accommodate habits well. Kids don’t argue over something they have done every day for years; they argue endlessly over change and unpredictability.

Give your children a warning a few minutes before their free time is ending, so they can finish whatever they are doing before you drag them away.

Order homework by subject. Start the hardest subjects first; position assignments which require memorization (spelling, math?) early and repeat after breaks.

Keep your expectations appropriate for your child’s age. As a general rule of thumb a child should have about 10 minutes of homework per grade level. Children in elementary school will need help organizing their work and staying on task; teenagers should be able to do their work without supervision. If all goes well, somewhere in middle school they learn to take responsibility.

Since you as parents won’t always be around to supervise, let your teenager fail in high school when they make poor choices. Summer school is cheaper and immensely less life altering than flunking out of college; repeating algebra is torture, but less traumatic than loosing a job.

Expect problems. Approach problems with diplomacy and respect for the person who is your child. Label the problem: “You get distracted by your cell phone.” Don’t label your child: never “You’re lazy.” Be willing to compromise with your child to solve the problem. “If you will turn off the cell phone while you do your work, you can have 5 minute breaks between subjects to catch up, call and text.” Agree to the compromise; it is a contract with your progeny. If you need to, write it down and both of you sign it. Read my blog on How to Fight with a Child.

Rewrite this contract when the first one flops, until you find an arrangement that enables your child to learn and you to not run screaming from the room.

Allow the child’s input as much as possible. Let him decorate his workspace up to the point where he puts in distractions. Let her decide subject order, as long as it works. Let them choose their break activity, up to a time limit.

Reward success. We as humans are hard wired to respond better to rewards than to punishment. How long would you go to work if you did not get a paycheck?

Sadly, it is not realistic to expect a better grade to be your child’s only reward. That grade is too far into the distant misty future, over a mountain of hard labor.

Rewards work best if they are small, and given for small increments of good behavior. A hug, a smile and pride in their accomplishment is all they need when they are small. When they are a little bigger, take time to read a book together or play a game. Keep rewards simple, small, and frequent.

Older children also need small, frequent rewards, though probably not as simple. They always have items that they want, but don’t need; these items make great rewards. Study time, completed homework and test grades can all earn them points toward a want. There is no need for an argument when he or she doesn’t do their work before picking up the phone; they just won’t get that essential point.

Homework is training for life. Choose the place and time, working with your child to fit it to your family routines, your child’s personality, and his or her age. Endeavor to teach self-discipline, time management and responsibility equally with reading, writing, and arithmetic. Reward success. Keep in mind that the goal is not to learn how to spell that list of words, but rather to inspire a love of learning which will propel your child to succeed, now and into the future.

DomesticatedMomster
The Blogger's Pit Stop

Che, Che, Che, Changes… and Children

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Change- just aheadBack-to-school season is the perfect time to think about how change impacts children, how to help them through it, and the positives that come when kids learn to be flexible and resilient.

Humanity is naturally comfortable with routine. We are confident in our ability to get through the day when we have done it all before. We are secure, and safe. We don’t have to particularly think about anything. To varying degrees, we all like to know what to expect–whole books are written about it!

This need for routine and stability is far more pronounced in a child. A toddler has no real sense of time–they live in the moment, and the future is a complete unknown. Older kids may have a better sense of time, but surprises can still incite strong emotion. Teens have so many changes going on already that seemingly small transitions can make them feel overwhelmed and out of control.

Yet change is inevitable, and the pace of change increases every day.  Parents today change jobs and geography more than did any previous generation; divorce is more common; the 24 hour cycle flings news at us continuously from around the planet.

Improvements in technology and rapid changes in our cultures remake our world the minute we turn our backs. So…

How to help children cope with change:

  • Be a good example. If you take things in stride and don’t appear worried or scared, they will imitate your reaction.
  • Build strong relationships. If they know they are loved and secure, a move or loss will not be so overwhelming.
  • Stay Healthy. Eat nutritious food, exercise, and get enough sleep. Everything is easier to deal with if you feel good and are not tired.
  • Warn them that change is coming. Imagine if even something as wonderful as Christmas happened without advance warning. There’s a tree in the living room, Dad is dressed up in a crazy suit, everyone is excited, and all the normal routines are suspended. Scary stuff! Let them know what is coming, and give them time to process.
  • Explain what is happening, and why it is happening, at their developmental level. Answer their questions. Give them information about the changes that are coming, and explore the possibilities. Imagine the good things that could happen as a result of the change as well as the bad and scary stuff.
  • Keep to routines when you can. Morning regimens, family meals, and bedtime routines are the foundation of a good day. Nothing feels safer than snuggling up with someone who loves you and a bedtime story.
  • Allow them their feelings. Don’t discount them. If the thing they are angry about the most with Grandma’s death is that no one will give them Tootsie Rolls anymore, nod solemnly and say you understand.
  • Expect bad behavior. Kids will regress with transitions, and will act out if they feel insecure. Discipline them in exactly the same way you would have before the change, because if they get away with bad behavior it will heighten their anxiety. If they still get a time out for saying that bad word, then things must not be that different. Bad behavior successfully disciplined establishes new borders and validates their security.
  • Let them have an impact on the change. Let them choose some flowers for an event, or the color of their new room for a move. Humans feel better when they have done something, no matter how small. Action shrinks fear.
  • Carve out time every day for a little one-on-one. ‘Nuf said.
  • Allow time for relaxation and fun. Laugh. Listen to music. Renee Jain, MAPP has a few excellent mindfulness activities for children here. I especially like her practice of “dissolving a thought.” Kids can devolve into what is called catastrophic thinking and spiral downward into a place where nothing is right with the world, and nothing ever will be. Mindfulness practice can stop that spiral and bring them back into the moment.
  • Avoid activities that increase stress, like competitive sports or games. This is not the time to play Monopoly. Simplify your schedule, and let things go.

Change is inevitable; learning to deal with it is a necessary skill. Kids who can adapt to new situations are better at everything from learning vocabulary to making friends to succeeding in the workplace.  Being able to manage your emotional responce to change is part of being a grownup. Knowing when to accept change and when to insist that you have an impact creates a fulfilling life. Last, seeing the good that can come from a transition is how you grab an opportunity.

The ability to adapt is one of the things that made humans special since we first started using that opposable thumb. Encourage your kids to learn it.

 

Domesticated Momster

 

The Blogger's Pit Stop

Zika Virus: An Update

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Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. Evidence shows that these babies may also have eye abnormalities that will  effect their vision. There have been links to serious deformities in the joints in the arms and legs of affected babies. A report published August 30, 2016 noted that 6% of the babies affected by Zika also have hearing loss. According to the AAP as of November 4, 2016, their are five main birth defects: severe microcephaly with partially collapsed skull, decreased brain tissue with subcortical calcifications, extreme muscle tone, eye damage with macular scarring and increased pigment, and limited joint motion range.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 0 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

DomesticatedMomster
The Blogger's Pit Stop

We Hold These Truths…

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Young Teenage Girl Standing And Looking On Empty Picture Frame

Truth: all humans are created equal. We can sometimes distinguish ourselves by our actions in life, but to believe that one person is inherently better than another because of something they were granted unearned at birth–whether it be skin color, religion, sex, or bank balance–is to live in a juvenile world of fairy princesses. Such a world is not fair to our daughters, or our sons.

When I was growing up, sexism was acceptable and assumed. It was displayed out in the open without shame, because obviously women were not equal to men. We weren’t strong enough to be bosses, couldn’t do math, and we made decisions based on emotion rather than fact. Daughters were expected to be mothers, teachers, or nurses.

Young women today tell me that no one is sexist anymore, but it has not been extinguished so thoroughly. It simmers beneath the surface, creeping unnoticed through our subconscious. This election brought it bubbling to the surface.

A woman I know took me to task years ago for saying how ridiculous I thought it was to have a president who couldn’t pronounce the word “nuclear.” She told me that I needed to have more respect for the office that he held, even if I hadn’t voted for him. That woman, this week, said on the internet that Hillary Clinton was a “rat-faced whore.”

How is it possible to contain those two thoughts in the same brain and not notice the imbalance? Deeply held, unconsidered prejudice.

Amy Richards said, “the last time most of us had a powerful woman in our lives, we were children and she was our mother.” We have no picture in our heads of what a powerful woman should look like. We expect the impossible of every woman–she must be pretty, personable, useful, bright, successful–so we apply that in the extreme to a woman who is breaking down walls. Then we stir in a little jealousy because who does she think she is to accomplish so much more than we did? As Ms. Richards added, “we punish her for excellence and success.”

The State Department and the Senate Intelligence Committee made mistakes in Benghazi, and four people died. Investigation into the incident found many at fault; the report mentioned Clinton one time. She did, however, assume responsibility, because she was  Secretary of State.

97 people died in  20 embassy attacks when George Bush was president. Only one was ever investigated at all.

The recent email scandal occurred because Clinton used her private account for official business, rather than a State Department account. This was common practice at the time, and indeed both Colin Powell and Condoleezza Rice did the same, as did the head of the CIA. No-one has called Colin Powell a criminal and demanded that he be jailed.

The anger toward this one woman is out of proportion, an extreme overreaction caused by beliefs instilled in our brains when we were still too young to reason.

I understand that people do not want to vote for someone just because she is female. We want our children to grow up in a world free of bigotry, not just reverse its direction. But I hope that they do not refuse to vote for her out of unconscious sexism. We are not obligated to vote for a woman simply because she is a woman; we are obligated to not blindly swallow the lies people spew out of a rancid sea of prejudice, because we have daughters.

To fairly evaluate a female presidential candidate we need to see past the overlay with which prejudice has painted them; we need to allow a strong woman to be a positive thing; and we need to look at actual facts.

Dig in. Think. Then Vote.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Rashes

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little cute girl near the pool with a circle for swimmingWhen the days warm up, pediatric offices see a lot of summer skin problems. Kids aren’t often ill during the summer, but they do get sunburns, bites, jellyfish stings, and rashes.

Sunburn

No one thinks about sunscreen on that first glorious sunshiny day, so sunburns are usually our first evidence that summer is here. Remember to use sunscreen, of course, and don’t forget to reapply it every hour.

If your child does burn, give ibuprofen immediately – it helps with the inflammation and can actually reduce the depth of injury. Use aloe generously: it lessens the pain, moisturizes the skin, and helps heal the damage. If the burn is bad, call your doctor. Prescription steroids and burn creams will help.

Bug Bites

Bug bites are also very popular in the summer, from mosquitos, fire ants, yellow flies, and fleas. Insects inject toxins into children’s skin when they bite; how much a particular child reacts depends on how sensitive he or she is.

Cover up little arms and legs when you can, especially if you are going to be outdoors around twilight. There are excellent clothing treatments available that will keep bugs away and last through several washings, protecting your child indirectly.

If your child is older than 2 months, use insect repellant with DEET on exposed skin, even though it’s nasty. It works and it’s a whole lot better than getting insect borne encephalitis. 10% DEET lasts about 2 hours; 30% lasts about 5 hours. Don’t use anything stronger than 30% on a child. Don’t reapply in the same day, and do wash it off when you go back inside.

Creams with pramoxine or calamine will help with itchiness. Cortisone creams help itch and also swelling and redness, but can only be used a couple of times a day. If there are lots of bites, an antihistamine by mouth will also help with swelling and itch.

Never use antihistamine creams (benadryl is the most common), because children can react to the topical antihistamine and actually get worse instead of better.

Bee stings

Bee and wasp stings are treated much the same way, after making sure to remove the stinger and apply a cool compress (and yes, Grandma’s idea about the wet mud does help).

Poison ivy, oak, and sumac

If your child is a forest dweller, he or she will at some point get poison ivy, oak or sumac. These plants produce a poison called urushiol in their sap and leaves, causing redness, itch and blistering.

The severity of this reaction also varies depending on your munchkin’s sensitivity. My brother’s eyes would swell shut if someone burnt it a block away; I could pull it up and throw it away with no reaction.

Wash both the child and his or her clothes as soon as possible. No lounging on the furniture! The toxin can stay on surfaces for months. Once the toxin is either absorbed into the skin or washed off, the rash is no longer contagious. Blister fluid does not contain urushiol.

The rash will develop first where the most toxin was deposited, in streaks and patches. It can spread for a week or so to the areas where less toxin landed, then take another two weeks to clear.

If the rash is mild, you can treat it at home with cool compresses, baking soda or oatmeal baths, the same creams you used for those pesky bug bites, and that antihistamine by mouth. See? Grandma was right again.

If the rash is not mild, or your child has it on their face, around their eyes, or on their genitals (and how did that plant get there?) call your doc. We can put them on steroids, which help enormously.

Jellyfish stings

If you harbor a small mermaid or man in your home, she or he may get stung by a jellyfish. There are some extremely dangerous jellyfish, so if your child has any trouble breathing, is weak or nauseated, has pain away from the sting, or has sweating, cramping, or diarrhea, call your doctor immediately.

If it is a simple sting, first remove the barbs by scraping it with a towel or a credit card. Don’t rub. Put suntan oil or salt water and hot sand on the sting; heat will deactivate the poison.

Do NOT wash the sting with fresh water – it will make the nematocysts (poison sacks) explode and release more poison into the skin. Your child will scream and not love you anymore. Put only fluids with lots of particles in them on the sting: sting-away, vinegar or steak sauce, for example. Ibuprofen will also help the pain and inflammation.

Allergic rashes

Last, we see allergic reactions to everything from sunscreen to henna tattoos to jewelry to pool chemicals from fun in the sun. Kids with sensitive skin or eczema will rash out in the summer from the heat, humidity and sweat.

By now you can probably sense a common theme (or you could just ask Grandma): give your itchy red bumpy child a cool bath with mild soap. Moisturize and apply topical steroids or give antihistamines by mouth.

If any of this doesn’t work, call me! It gets lonely in a pediatric office during the summer when all the kids are healthy.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Injuries: Preventing the Scary Stuff

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safety signSafety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous—but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure themselves… Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait… That’s me! So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket. All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?

Domesticated Momster
The Blogger's Pit Stop

The Trickle Down Theory of Bigotry

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kids with instruments-01Enough.

I  know it’s been an interesting ride. We’ve never seen a political candidate like Donald Trump before. He gives vent to the inner two year old, the child who knows he’s better than anyone else and doesn’t let logic, truth, or empathy get in his way. He wants what he wants, and he will say and do whatever it takes to get it – classic two year old behavior. Watching him is like spending a day at the circus.

The problem is that he is a bully, a liar, and a bigot – traits which spit in the face of American ideals like equality, opportunity, and freedom of speech – and our children are watching. When our children see us supporting him for the highest office in the land, they might reasonably believe that we think bullying, lying and bigotry are acceptable.

They are not.

In a speech on caucus day in Cedar Rapids, Iowa, Trump told his audience that he would pay the legal fees of followers who beat up protesters at his rallies.

After two brothers in Boston who beat up a homeless Latino man said that they were inspired by Trump’s anti-immigrant message, Trump suggested that the men were well-intentioned and had simply gotten carried away. A two on one well intentioned beating?

Last November, Trump supporters attacked an African-American protester who was chanting “Black lives matter.” They hit him, knocked him down, and continued to kick him after he was on the ground. Afterwards, Trump suggested that their behavior was justified. “Maybe he should have been roughed up,” he was quoted, “It was absolutely disgusting what he was doing.”

Hmm.

It reminds me of the sixth grade bully, gathering his friends behind him to beat up the unpopular kid, then trying to shift blame to the victim.

The Washington Post wrote that “Trump in this campaign has gone after African Americans, immigrants, Latinos, Asians, women, Muslims and now the disabled.” He physically mimicked Pulitzer Prize-winning journalist Serge Kovaleski, who suffers from arthrogryposis, a congenital joint condition that affects the movement in his arms.

Can you imagine sitting in the Principal’s office, hearing that your child had done such a thing?

How are we to explain to our daughters that brains, talent and hard work are more important than breast size when the man we are considering for president says that “it really doesn’t matter what the media write as long as you’ve got a young, and beautiful, piece of ass.”

Last, most of us agree that teaching our children not to lie is an important part of parenting. Mr. Trump’s truth rating on the Pulitzer prize winning site Politifact is 2%.

According to the Southern Poverty Law Center, teens in Merrillville, Ind., at the predominantly white Andrean High School recently chanted “Build a wall” at their counterparts from predominantly Latino Bishop Noll Institute during a basketball game. Similarly, fans of Elkhorn High School in Wisconsin chanted “Donald Trump, build that wall!” at a girls’ soccer game against Beloit Memorial High School, whose team is largely Latina or black.

A survey of 2000 K through 12 teachers done by Teaching Tolerance reported an increased anxiety level and an upswing in bullying, harassment and intimidation among kids inspired by the appalling misbehavior throughout this campaign.

A kindergarten teacher in Tennessee wrote, “a Latino child—told by classmates that he will be deported and trapped behind a wall—asks every day, “Is the wall here yet?””

The “trickle down” theory of bigotry and bullying. If my parents admire this man, and this man says that Mexicans are rapists and women are disgusting animals, then it must be all right for me to think that also.

Most of us do not dream of our children growing up to be bullies and bigots.

Dr Martin Luther King said it better than I ever will:

The ultimate weakness of violence is that it is a descending spiral, begetting the very thing it seeks to destroy. Instead of diminishing evil, it multiplies it. Through violence you may murder the liar, but you cannot murder the lie, nor establish the truth. Through violence you may murder the hater, but you do not murder hate. In fact, violence merely increases hate. So it goes. Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that.

So, enough. Remember the basics: respect for our fellows, equality, honesty, justice…

Your children are watching.

Domesticated Momster

Top Ten Tips for Summer Vacation Success

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skateboarder-01School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten tips:

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!